Patient Insurance Plans​

Patient Insurance & Health plans which we accept:

We know that many individuals are either uninsured or under-insured due to the difficult economy and changing workplace insurance coverage. In some cases, we have seen patient co-pays and deductibles skyrocket to the point where, in many cases, we can offer better prices for our service outside of your network coverage. Please contact us to review the best option for you.

Treatment procedures usually require preauthorization and our office will initiate and conduct the request process. We inform patients usually within one or two days when treatment is authorized. We may schedule a procedure during a consultation if we do not anticipate an insurance company denial.

Bay State Pain Associates Health System contracts with all major health insurance carriers in MA. Please call your insurance company and ask about your specific health services coverage and what if any copayments, co-insurances and deductibles may apply to you.

Depending on whether you have insurance, and the extent of your coverage, you may be asked to make a payment at the time of your visit. We suggest that you contact your health insurance  plan before your appointment to verify benefits and coverage and to confirm that your Bay State Pain Associates physician is a participating provider.

Is my Bay State Pain Associates provider covered by my insurance plan?

To find out if Bay State Pain Associates is a participant in your healthcare insurance plan, you will need to call the phone number on your insurance card.

Before you schedule an appointment or procedure, always check with your insurance carrier to determine your policy’s benefits and any pre-visit requirements. As a patient, it is your responsibility to ensure you are covered for any services you receive and to provide accurate insurance information to facilitate the billing process. If you have questions regarding accepted insurance, please call our office in West Bridgewater or Norfolk 

Patient Insurance & Participating Health Insurance Plans

We fully participate with:

BCBS, Mass Health, Medicare, Tufts, harvard pilgirm, BMC and more . we accept most major insurance plans.  Please contact our offices prior to your appointment to determine if we are providers for your health plan.

OUT OF NETWORK Insurance Plans

If Bay State Pain Associates Clinic is not  a participating provider with your insurance plan, we will assist you in obtaining benefits from your insurance company, but ask that you make payment at the time of your visit.

Still have your physician send a referral. Our doctor  will review your case and make a determination about our ability to treat your condition. Once a determination is made we will contact you. We are out of network with the plans listed below. Your share of the cost will be higher. Please contact your insurance to understand your out-of-network benefits.

ACCEPTED ON A CASE-BY-CASE BASIS

Our doctor will review your case and make a determination about our ability to treat your condition. Once a determination is made we will contact you.

No Insurance

If you do not have health insurance, we ask that you make payment at the time of your visit. Please contact Bay State Pain Associates coordinators  if you have questions.

If you don’t see your insurance plan listed, you can contact us to verify whether we participate with your plan.

Payments

Your co-payment, co-insurance and deductible are due at the time of your visit.  If you require surgery, a payment request may be made prior to scheduling. For your convenience,

Bay State Pain Associates accepts cash, personal checks, and most major credit cards.

You will not incur any out-of-pocket expense for the Priority Consult review. However, if your insurance company is contracted to pay

Bay State Pain Associates Clinic for the dr’s review, this payment will be reflected on the Explanation of Benefits (EOB) from your insurance company. This is for your information and is not a bill.

If the dr recommends an appointment, treatment or procedure then that appointment will be billed to your insurance, and you may incur out-of-pocket expenses.

Please remember to bring your insurance card, Medicare or Medicaid card with you to your office visit. If you do not bring your card, we will ask that you pay at the time of your visit.

Health Plan or Managed Care Plan

If you are enrolled in a health plan or managed care plan, your co-payment will be collected before you see the doctor.

Medicaid/Managed Medicaid

If you are enrolled in a Managed Medicaid plan, your co-payment will be collected at the time of your visit. No payment is required for traditional Medicaid. A physician referral is required for both Medicaid and Managed Medicaid patients.

Medicare/Managed Medicare

If you are enrolled in traditional Medicare, 20% co-insurance will be collected at the time of your visit. However, if you have secondary coverage to Medicare, no payment is required.

If you are enrolled in Managed Medicare, your copayment will be collected at the time of your visit.

Workers’ Compensation and Self-Insured Employer

If you are being seen for a work-related injury, your claim must be approved by the Bureau of Workers’ Compensation or self-insured employer.

If approved, please provide the following information: date of injury, claim number, the name and billing address of the managed care organization that administers your benefits, and the name of your treating physician.

If your claim is pending or not approved, Bay State Pain Associates will submit a claim to your health insurance company. If you do not provide your workers’ compensation claim number, and you do not have health insurance, we will ask that you make payment at the time of your visit.

Patient Financial Responsibilities

Insurance: 

Our providers are In-Network with most major insurance carries. If your insurance plan is one with which we are not a participating provider, you will be responsible for payment in full.

Referrals and Prior Authorization:

Many insurance plans require you to obtain a referral from your primary care physician and/or prior authorization before seeing a specialist. You are responsible for obtaining any necessary referrals and authorization before your appointment to receive maximum coverage for our charges. If a referral is not obtained, you may be responsible for the entire visit balance.

Co-payments, Coinsurance, Deductibles:

Your co-payment is due at the time of service. If you have a high-deductible plan or coinsurance, we may request a pre-payment to cover your estimated out of pocket amount prior to your date of service. For your convenience, we accept cash, personal checks, Visa, MasterCard, American Express and Discover.

Financial Arrangement for Procedures:

If your treatment includes a  procedure, we will obtain a prior authorization for the  procedure with your insurance carrier. We will also verify your insurance benefits and
obtain your coinsurance and/or deductible. Using this information, we will estimate your out-of-pocket portion of the charges for our services. The estimated amount will be reviewed with you before surgery is scheduled. A prepayment request will be made at that time. Actual services and your final out-of-pocket cost obligation may vary
from the estimates. Financing may be available with no interest or low interest through Care Credit.  

Self-pay and Out-of-Network:

If you do not have insurance coverage or if our providers are out-of-network with your insurance plan, you will be expected to pay at the time of service. Pre-payment may be requested for procedures. It is your responsibility to know if our providers are in network with your plan.

AWARD WINNING CARE
Dr. Algendy has been ranked in the top 10 pain management doctor by Vitals.
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ONGOING PATIENT SUPPORT
At Bay State Pain Management we are always available to take care of your personal needs. We are available through phone, fax, E-Mail, or our patient portal. We don’t send out patients to the ER unless it is a true emergency.
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